Analytic study of laryngeal mask airway cuff pressure on the pharyngeal mucosa and postoperative adverse airway events

Sixty patients scheduled in order to calculate the pressure exerted by the cuff upon the pharyngeal mucosa and incidence of adverse airway events [hypoxia, hypercarbia, coughing, regurgitation, vomiting, airway obstruction, hiccup or biting]. At the end of surgery patients were interviewed about pharyngolaryngeal morbidity [sorethroat, dysphagia and dysphonia] immediately before leaving the post- anesthesia care unit and 24 hours following surgery. Patients were divided into three groups, each 20 patients were studied for each of the size 2, 3 and 4 laryngeal mask airway [LMA]. A noninvasive method was used to compare intracuff pressures. Cuff inflation with normal injection volumes recommended resulted in the residual volumes of the cuffs being exceeded. The intracuff pressures recorded with the mask in situ at these normal injection volume were in the range of 103-251 mmHg. The calculated transmitted mucosal pressures were substantial for all three sizes of the cuff and potentially exceeded the capillary perfusion pressure of the adjacent pharyngeal mucosa, despite apparent pharyngeal accommodation to the mask. Analysis showed more partial airway obstruction in the LMA size 2 group, also heart rate was slightly higher in LMA size 2 group upon arrival in the post- anesthetic care unit [PACU], otherwise there is no differences in cardio-respiratory responses. Sore throat and dysphagia were more common in the LMA size 2 group. The transmitted pharyngeal mucosal pressure were calculated over the clinical range of injection volumes. Study concluded that in general, emergence characteristics with the laryngeal mask airway are not influenced by volume of air used to inflate, but that postoperative sore throat and dysphagia are more likely at high initial cuff volumes

Assessement of patient-controlled analgesia using remifentanil as an effective and safe alternative to patient-controlled epiduralúanalgesia for labour

This study compared the administration of intravenous infusion of remifentanil using patient-controlled analgesia [PCA] device for analgesia in normal labour with that of 0.1% bupivacaine plus sufentanil 0.5 microg/ml via patient-controlled epidural analgesia [PCEA]. One hundred healthy pregnant women at term with a single fetus with a vertex fetal presentation were divided in two equal groups to receive either 0.25 microg to 1 microg/kg as bolus dose of remifentanil PCA in a stepwise manner with or without a background infusion [0.025-0.05 microg/kg] or 0.1% bupivacaine and 0.5 microg/ml sufentanil using PCEA. Pain Score on visual analog score [VAS]. Modified bromage scale [0-3]. Level of sensory block, drug use, supplemental boluses and side effects were recorded. Mode of delivery, duration of first and second stages of labour, umblical cord pH, Apger scores of the newborn and a measure of maternal satisfaction were recorded after delivery. VAS pain score during the progress of labour was significantly less in bupivacaine group PCEA [16.9 +/- 13.4mm] compared with the lowest pain scores in remifentanil group recorded at L[1]B[1] bolus 0.25 microg/kg [30.2 +/- 23 mm] and at L[1]B[2] bolus 0.5 microg/kg [24.4 +/- 18 mm] respectively, P<0.01, Maternal satisfaction with the relief of contraction pain was greater in bupivacaine group [90.8 +/- 10.8] than in remifentail group L[1]B[1] 70.20 +/- 20 mm, L[1]B[2] 50.2 +/- 12.8] P<0.0001, as with the relief of delivery pain [bupivacaine group 88.7 +/- 14.1 mm, L[1]B[1] 78.3 +/- 2.3 mm, L[1]B[2] 80.1 +/- 25.2 mm] P < 0.0001. On visual scale: 0 = not satisfied, 100 = fully satisfied. Motor and sensory block were assessed with the progress of labour in bupivacaine group. No differences were seen between the two groups for mode of delivery, maternal blood pressure, fetal heart rate, apger score 0, 5, 10 min and umblical pH. Patients in remifentanil group requested more supplemental boluses to achieve labour analgesia than those in bupivacaine group, adding background infusion at level two or three bolus doses not reduce pain scores but serves only to increase respiratory depression, sedation and opioid side effects [vomiting, nausea and itching]. Delivered as patient-controlled epidural analgesia 0.1% bupivacaine plus 0.5 microg/ml sufentanil are more potent than PCA remifentanil. Remifentanil PCA system [bolus doses 0.25-0.5 microg/kg without a background infusion] may safely provide worthwhile, although incomplete analgesia for labour

Neostigmine intrathecal and transdermal nitroglycerine augment intrathecal bupivacaine-fentanyl postoperative analgesia following lower limb surgery

Sixty patients were scheduled for lower limb operations. Their age ranged from 24 to 49 years [mean 41.7 +/- 6.4]. Patients were divided into four groups each group included 15 patients. All patients were given intrathecal bupivacaine - fentanyl, plus group [I] was given [non transdermal nitroglycerine patch] as placebo, group [II] transdermal nitroglycerine patch 5mg /24 hours, group [III] intrathecal neostigmine 10 ug and [non transdermal nitroglycerine patch] as placebo and group [IV] transdermal nitroglycerine patch 5mg /24 hours plus intrathecal neostigmine 10 ug. All groups were assessed for intraoperative and a period of postoperative 24 hours for vital parameters, postoperative analgesia and duration of effective analgesia as time from intrathecal drug administration to the patients first requested for analgesic medication, adverse side effects and total dose to control pain in 24 hours postoperative. Results of this study revealed multiple drug combination may be useful in extending postoperative analgesia of spinal bupivacaine - fentanyl associated with transdermal nitroglycerine patch and neostigmine intrathecal .Suggesting that transdermal nitroglycerine patch and neostigmine may enhance each other's antinociceptive effects at the dose studied

Pattern of plasma gastrointestinal hormones in some gut diseases

The present work was conducted on 47 patients as well as 12 healthy controls aiming to investigate the plasma patterns of some gastrointestinal peptides including gastrin, cholecystokinin, vasoactive intestinal peptide and beta- endorphin in patients with some gastrointestinal disorders including gastric ulcer, duodenal ulcer, mild reflux esophagitis and severe reflux esophagitis for the evaluation of the diagnostic and therapeutic applications of these peptides in the diseased states of the gut. The statistical analysis of the results revealed a highly significant increase in the plasma gastrin and VIP levels and a highly significant decrease in the plasma beta-endorphin and CCK levels in gastric ulcer group when compared with the control group

Plasma free fatty acid levels in ischemic heart diseases

To evaluate the pattern of plasma free fatty acids [FFA] in ischemic heart diseases, we compared patients who had suffered a myocardial infarction with age matched control subjects free from clinically apparent ischemic heart diseases. We found significant low levels of serum palmitic. stearic. oleic, linoleic and linolenic acids in acute myocardial infarction [AMI] group as compared with healthy control one. Whereas no significant difference was found between chronic myocardial ischemia [CMI] and acute myocardial ischemia [AMI] groups On the other h and, there was significant low levels of palmitic, stearic and oleic acids in CMI group as compared to healthy control one. The positive ecological correlations between national intakes of total fat and saturated fatty acids and cardiovascular mortality found in earlier studies were questionable or absent in our recent study

serum magnesium level in ischemic heart disease and relathionship to cardiac complications

To evaluate the serum magnesium [Mg] levels in patients with ischemic heart disease [IHD], eighty five patients with IHD were selected from patients of coronary care unit in Mansoura University Hospital 52 with chronic IHD without myocardial infraction [MI] and 33 cases with acute MI 25 cases out of the 52 patients with chronic IDH were presented by arrhythmias and remaining 27 patients had no arrhythmias-On the other hand 16 cases with acute MI were presented by arrhythmias and remaining 17 patients were non arrhythmic. In the present study the mean serum Mg levels in patients with IHD- with and without AMI; patients with chronic IHD and patients with acute MI were significantly lower [p<0.001] than the level in normal controls. There was in significant decrease in mean serum Mg in subgroup with arrhythmias when compared to those without arrhythmias [p>0.05], however a insignificant decrease [p<0.001] was observed in patients with IHD [with and without MI] patients with chronic IHD develop left ventricular failure [LVF] when compared to those who escape this complication in the same group. Also there was significant hypomagnesemia in patients without acute MI who complicated by premature ventricular contraction [PVCs] when compared to normal controls from the present study we can conclude that hypomagnesemia- in addition to hypokalemia - is a predisposing factor to dangerous complication in patients with IHD and the addition of Mg to the conventional therapy can reduce the incidence of complications in these patients

Fetal and maternal vitamin E content in correlation with blood lipids

The present study was designed to investigate the correlation between plasma Vitamin E and total lipids, cholesterol and triglycerides in maternal and umbilical cord blood. Levels of Vitamin E total lipids, cholesterol and triglycerides were significantly higher in maternal plasma[P > 0.001] vitamin E/total lipids ratio in cord blood was higher than that of maternal blood. Correlation of vitamin E levels with cholesterol and triglycerids levels in maternal group and cord blood group revealed no significant correlation the only significant correlation was between vitamin E levels with total lipids level in cord blood group where r = 0.673 and [p > 0.001] but no significant correlation in maternal blood. Since Vitamin E and lipids share a common lipoprotein carrier proteins

Effect of starvation and water depletion on the structure and function of the immunological system of albino rats

48 albino rats, 200-250 gm. body weight comprised the material for the present work. They were classified into 2 groups. The1st group was deprived from food while the 2nd groub was deprived from water as well. A third group of 6 animals used as control. The animals within the 1 st and 2nd groups were subdivided into 4 subgroups and used to study the effect od atarvation and stravation aasociated with dehydration for 3, 6, 9 and 12 days respectively on the structure and the function of the immunological system. It was found that atrophic changes inorm of lymphocytic epletion with absence of germinal centres occur in spleen, lymph nodes and tonsils after the first week. The atrophic changes were more marked in the group of starvation with dehydration. Also, efinite thymic involution was demonstrated from the start of the experiment in both groups. On the other hand relative increase in the gamma globulin occurred. At the same time decreased ymphocytic transformation reflecting an impairment of cell mediated immunity was demonstrated in the present study. The impact of these findings on existing public health and vaccination rograms are of importance and must be taken in consideration

Biochemical studies on human cervical mucous in infertility

We studied 25 infertile women in whomn in whom cervical hostility was the only known cause of infertility, and 10 fertile women. Total soluble proteins, IgG, IgA and IgM togeter with zinc, copper manganese and lead were measured in mid-menstrual cycle cervical mucus. IgG and IgA were present in the cervical mucus of all the women. But IgM was detected only in 20% of samples of fertile women and in 36% of samples of infertile women. Levels of IgA and total soluble proteins were significantly higher in the infertile group. Zinc, Copper and manganese were present in cervical mucus and the concentrations found did not differ significantly in the tow groups. Lead was not detected in all cervical mucus samples in the two groups

Immunoglobulins, peptides and trace metals in seminal plasma of fertile and infertile males

The biochemical characteristics of human seminal plasma and the possible role of these parameters in relation to infertility problems were the aim of this study. In the present work semen samples were collected from 64 males attending the infertility Clinic and Family Planing Unit of Mansoura University Hospital, for problems concerning infertility and fertility regulation. Semen samples were subdivided into normo, astheno, oligoastheno and azoospermic groups according to the recommendation of the European Androlgy Club 1970. The seminal plasma samples were analysed for total plasma proteins, immunoglobulins IgG, IgA and IgM, fractionation of peptides and the trace metals Zn, Cu, Mn and Pb. It has been concluded from the present work that the essential trace elements, zinc, copper and manganese are always present in seminal plasma, zinc may be positivly correlated with spermatozoa count and to less extent with motility. Lead which is non-essential metal, and a toxic cumulative environmental pollutant was not detected in semen. The decrease in total seminal plasma proteins observed in azoospermic semen may reflect endocrine imbalance or anatomical abnormality. The peptides-types and concentrations-in the seminal plasma were variable in the different groups of semen. It is of value to call for more detailed studies aiming at identification of chemical nature, and source of these peptides, and to study their effects in spermatozoa metabolism, motility and fertilizing capacity. Immunoglobulins G and A are normaly present in the seminal plasma and may play a role in protection against infections by bacteria or viruses, but under certain abnormal conditions the level of IgG and IgA [in particular] significantly increase either by transudation from blood and/or local production, and an altered immune response may occur leading to auto-antibody in the male against spermatozoa which results in sperm agglutination or immotility. IgM is not present in seminal fluid of both normal and abnormal semen groups as it is a macromolecule and non-diffusible through the blood-prostate barrier